Abstract

Non-alcoholic fatty liver disease (NAFLD) is becoming one of the most common causes of chronic liver disease worldwide and a major cause of liver-related morbidity and mortality.

NAFLD includes simple hepatic steatosis and non-alcoholic steatohepatitis (NASH), a condition where steatosis is associated with hepatic inflammation with or without fibrosis. Pathogenesis of these conditions is complex, but insulin resistance and obesity play a major role, together with emerging evidence for adipose tissue dysfunction, adipokines, and gut microbiota as important contributors. Non-alcoholic fatty liver disease and type 2 diabetes are common conditions that regularly co-exist and can act synergistically to drive adverse outcomes. It’s hard to predict the disease course in an individual. Most of the patients will have stable liver function and will not develop serious complications. But in some patients NASH may cause severe fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Subjects with compensated NAFLD-related cirrhosis have an annual overall mortality risk of 3.5–4%. All patients with decompensated liver cirrhosis should be evaluated for liver transplantation (LT). In Western countries, NASH is predicted to become the most frequent indication for LT in the next 20 years. NAFLD is becoming the major cause of HCC, with a steadily rising trend. Although HCC predominantly occurs in the setting of cirrhosis, the chance of HCC occurrence in non-cirrhotic liver is a worrisome aspect of NAFLD. Current knowledge of the pathways in hepatocarcinogenesis is still limited, so present interventions should be directed to prevention of metabolic syndrome and NAFLD, reducing the risk of HCC through lifestyle changes such as exercise and dietary modification.

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